Hydrocephalus in Children with Tuberculous Meningitis

  • Iskandar Iskandar Departement of Surgery, Faculty of Medicine, Syiah Kuala University, Banda Aceh
  • Rovy Pratama Departement of Surgery, Faculty of Medicine, Syiah Kuala University, Banda Aceh
Keywords: Hydrocephalus, TB meningitis, surgical procedure

Abstract

Hydrocephalus is an enlarged brain ventricle as a result of an increase of cerebrospinal fluid (CSF) caused by an imbalance between production, circulation and its absorption. Hydrocephalus can be divided into two groups are congenital and acquired hydrocephalus. Central nervous system (CNS) infections such as Tuberculous (TB) meningitis is one of the causes of hydrocephalus. TB meningitis is the most common TB CNS manifestation in total incidence of extrapulmonary TB. Hydrocephalus is a common complication of TB meningitis, and almost always appears at 4-6 weeks after having meningitis.Hydrocephalus in TB meningitis can be communicating or obstructive; between them, communicating  hydrocephalus occurs more frequently. Hydrocephalus occurs because of the blockade of the basal cysterna by a thick exudate. Other causes are due to the formation of arachnoid granulation which inhibits absorption of CSF, excessive CSF production because the coronary plexus and ependima are inflamed, and the formation of scar tissue (skar)  in the subarachnoid space in the advanced phase.There are various diagostic modalities to evaluate the hydrocephalus due to TB meningitis, such as CSF analysis and radiological examinations such as CT scans and MRI. Clinically, the severity of the disease can be determined using the Bhagwati grading system, modified Vellore grading or MRC staging. Conservative treatment does not promise significant improvements and is very susceptible to deteriorating prognosis, so invasive procedures and surgery such as ventricular tabs, ventricular shunts, or endoscopic third ventriculostomy (EVT) are necessary.

Published
2019-02-08